Provider Demographics
NPI:1275167983
Name:NTALLA-KONSTANDIS, CHARIKEIA (LP)
Entity Type:Individual
Prefix:
First Name:CHARIKEIA
Middle Name:
Last Name:NTALLA-KONSTANDIS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 35TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4803
Mailing Address - Country:US
Mailing Address - Phone:917-915-6307
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8018
Practice Address - Country:US
Practice Address - Phone:917-915-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001065102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst